Summary Report for FSPSAs Initiated During the Report Period Center: 02
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start date of service authorization occurs during the report period). This report does not
represent all FSPSAs that overlap the report period. Note that service authorization periods may
range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs starting between: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3774 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Cost of Avg Fee
Children Records Authorized Auth Services Per Unit Auth
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 3 3 2.008675 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.166667 $6.1700 $37.0100
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Subtotal (Total Children Is Unduplicated) 4 4 2.175342 $6.1700 $2.8400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 39 43 24.935159 $1209.3700 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.7000 $23.7000
EXIT -EXIT EXIT ASSESSMENT 69 69 66.224658 $3311.2400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 6.005479 $450.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 4.005479 $222.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 134 134 235.079447 $17630.9800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 61 61 97.058900 $7279.4300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 193 193 333.006448 $18481.8800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 66 66 127.510958 $9563.3300 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 7 7 2.370166 $120.9900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 1.511111 $77.1400 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 15 15 5.238357 $267.4200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 19 19 10.554415 $538.8000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 12 13 5.120168 $261.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.788889 $40.2700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 9 2.474276 $126.3100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 24 24 16.443303 $839.4300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 1.194445 $60.9800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.147945 $7.5500 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 48 48 40.869384 $2086.3900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.128767 $6.5800 $51.0600
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Subtotal (Total Children Is Unduplicated) 360 722 988.667754 $63069.7500 $63.7900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 50 55 51.764404 $258822.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 79 83 85.964135 $4298.1800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.900000 $22.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 257 275 528.476550 $26423.8200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 136 140 237.333331 $11866.6500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.433333 $10.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 25 42.599999 $2130.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 234 236 375.000005 $18750.0300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 3.666667 $91.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 282 290 1794.223827 $89711.1900 $50.0000
INTR -T1013 INTERPRETER 26 49 94.390998 $4719.5500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 322 603 2211.645747 $22116.4500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 67 67 526.362952 $37603.3700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 24.000000 $1372.8000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 58 59 473.079762 $33796.7900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 6 32.348337 $1849.0300 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 72 74 557.558188 $39831.9600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 17.714286 $245.8700 $13.8800
TRAV -TRAVS Travel by mile 424 1078 164893.419790 $73377.5700 $0.4500
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Subtotal (Total Children Is Unduplicated) 464 3048 171950.882311 $627040.2400 $3.6500
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Total 3774 172941.725407 $690116.1600 $3.9900
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Number of Children (Unduplicated) With at Least One Authorization 490